Scotland's health and social care delivery plan


By Paul Carey-Kent, Policy Manager, CIPFA

At the end of 2016, the Scottish Government published a 38 page national delivery plan to up the pace of improvement and change within Scotland’s health and care system. NHS boards are required to set out their contributions to driving this forward in their Local Delivery Plans for 2017/18.

As is usual with such strategic level documents, there are more statements of goals and intended outcomes than there are specific, quantified and funded actions to change what is delivered.

The overall aim is a health and social care system that is integrated; focuses on prevention, anticipation and supported self-management; makes day-case treatment the norm; puts the person at the centre of all decisions; and ensures hospitalised people get back into their home as soon as appropriate. 

To deliver that, the Scottish Government cite a ‘triple aim’ of:

  • investing up front to improve services
  • promoting and supporting healthier lives and reducing health inequalities, adopting an approach based on anticipation, prevention and self-management  
  • ensuring that the balance of resource is focused on prevention and early intervention. 

All of that is consistent with the NHS goals currently being advanced in England through Sustainability and Transformation Plans (STPs). Where the STP process focuses strongly on savings requirements, however, the Scottish framework does not (though there are financial pressures and performance problems, as highlighted by National Audit Scotland’s recent report). 

The Health and Social Care Delivery Plan concentrates on areas of improvement on the back of £128m of change funding in 2017-18. The report doesn’t set out specific funding commitments, as these will be contained in ‘a financial plan which will support this delivery plan’, and it is recognised that this will need to ‘put in place arrangements to support sustainable financial balance’ and  ‘create short-term financial capacity to allow time to deliver change through efficiencies in current ways of working’. 

To turn that vision into reality requires that concrete actions are identified under the key headings of integration, clinical strategy and public health improvement (as well as plans to consider NHS Board reform, and some cross-cutting actions).

Scotland is already more integrated than England, as there are 14 NHS boards, 32 local authorities, with a single commissioning body (Integrated Joint Board (IJB)) managing the budget for health and social care. In order to push on in that context, action is centred on three key areas: reducing inappropriate use of hospital services; shifting resources to primary and community care; and supporting the capacity of community care. 

In more specific terms it is planned to:

  • Ensure Health and Social Care Partnerships make full use of their new powers and responsibilities to shift investment into community provision. By 2021, spending on primary care will increase by £0.5bn within the £11bn spend on health, implying a considerable shift away from secondary care. Consistent with that, other promises include that by 2022 there will be ‘more GPs, every GP practice will have access to a pharmacist with advanced clinical skills and 1,000 new paramedics will be in post’; and that by 2018, every child with needs identified through the Universal Health Visiting will be offered a minimum of 11 home visits including three child health reviews by 2020.
  • Agree with partners on plans to deliver a 10% (400,000 day) reduction by 2018 in unscheduled bed-days in hospital care by reducing delayed discharges, avoidable admissions and inappropriately long stays.
  • Provide all those with complex care needs or long-term conditions with a ‘Key Information Summary’ to support their future care plans and end of life preferences, and increase personalised care and support planning. 

The plan also calls for a concerted, sustained and comprehensive approach to improving population health through:

  • the creation of a set of national public health priorities during 2017
  • the establishment of a new, single, national body for public health
  • developing ways to strengthen local partnership arrangements to support the delivery of public health priorities.

Among the specific targets which go along with that public health agenda are:

  • reducing smoking rates from 21% now to 5% by 2034
  • seeking to introduce a minimum unit price for alcohol
  • consulting on a new strategy on diet and obesity
  • delivering the Maternal and Infant Nutrition Framework by 2022, with for example universal vitamins to all pregnant women by 2017
  • improving access to mental health support by rolling out computerised cognitive behavioural therapy services nationally by 2018.
With Wales and Northern Ireland also differing from both England and Scotland, it will be interesting to follow how the funding / savings approaches needed to deliver on these ambitions develop; and how and to what extent the frameworks for achieving parallel end goals diverge between the UK’s nations.

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